Provider Demographics
NPI:1710370887
Name:GUILLEN, PAOLA
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1173
Mailing Address - Country:US
Mailing Address - Phone:888-353-8285
Mailing Address - Fax:877-805-3084
Practice Address - Street 1:15315 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1173
Practice Address - Country:US
Practice Address - Phone:888-353-8285
Practice Address - Fax:877-805-3084
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-10362103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-14-10362OtherBCBA CERTIFICATE